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The Medical Board of California initiates disciplinary action against antivaccine “hero” Dr. Bob Sears. It’s about time.

After all the bad news that I’ve been blogging about, it’s a pleasure for me to end the week with a bit of very good news, very good news indeed. That news came in the form of an article published in the Orange County Register with the glorious title Dr. Bob Sears faces medical board discipline in recommendation not to vaccinate.

Behold:

Dr. Bob Sears, the Capistrano Beach pediatrician who is an outspoken critic of mandatory vaccination laws, faces possible state Medical Board discipline after he recommended that a 2-year-old patient forgo immunizations, according to legal documents made public Thursday.

The board accuses Sears of committing “gross negligence” in 2014 when he wrote a letter excusing the toddler from future vaccinations after the child’s mother described an adverse reaction as an infant.

The documents say Sears failed to obtain a detailed medical history documenting the unidentified boy’s prior vaccines and reactions, which was necessary for making an evidence-based decision. Sears’ recommendation left the patient and “his future contacts at risk for preventable and communicable diseases,” the documents say.

Sears declined to comment Thursday.

If the board finds Sears negligent, he could face discipline ranging from a public reprimand to revocation of his medical license.

My first thought when I saw this story was: Excellent. It’s about time! Personally, like some of you, I consider Dr. Bob to be an antivaccine quack. That is my opinion, but it is one that I can give quite a few evidence-based reasons for and have been doing for years now. Given Dr. Bob’s history of opposing SB 277, the new California law that eliminated nonmedical exemptions to school vaccine mandates and his willingness to give paid seminars teaching parents to avoid the requirements of SB 277 and even outright selling nonmedical exemptions, I consider him a menace to public health, particularly that of children in California and beyond. Physicians who betray public health and the health of their patients by not only failing to vaccinate but actively seeking to subvert SB 277 (not oppose, which is Sears’ constitutional right, but to actively subvert it now that it’s passed by writing what I consider to be dubious medical exemptions based on bogus antivaccine pseudoscience), a law designed to maintain high rates of vaccination, do not deserve their medical licenses, as they are not practicing anywhere near according to the standard of care. I thus view the Medical Board of California’s action with strong approval, strong approval indeed.

That is my opinion of Dr. Bob and what he deserves. Now the Medical Board of California is actually acting against him.

When I read this story, I also couldn’t help but wonder initially if this action was over an incident that a reader reported to me, complete with letters signed by Dr. Sears recommending exemptions from school vaccine mandates based on what I considered to be bogus medical reasons based on the mother filling out an online application and paying a fee. It rapidly became clear that it wasn’t when the news story stated that the incident resulting in this complaint occurred in 2014. The legal filing by the State of California tells the tale, the tale being about a young boy named J.G. (for purposes of court hearings):

On April 3, 2014, two-year-old J.G. presented to Respondent for the first time. He was seen by Respondent for what medical records describe as a “two year.” The visit of this date includes a summary of the patient’s history with a brief description of J.G.’s prior vaccination reaction, as described by the patient’s mother. Her description included, “shut down stools and urine” for 24 hours with 2 month vaccines and limp “like a ragdoll” lasting 24 hours and not himself for up to a week after 3 month vaccines.

Respondent wrote a letter dated April 13, 2014 excusing patient J.G. from all future vaccinations. The letter indicates that the patient’s kidneys and intestines shut down after prior vaccinations and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours starting approximately ten minutes after his vaccines, with lethargy.

The letter dated April 13, 2014 was not maintained in patient J.G.’s medical chart in Respondent’s office.

There’s more, including other visits to Dr. Bob. I wonder what Dr. Bob’s antivaccine fans would think if they learned that he actually administered the dreaded Tamiflu to J.G. later (January 2015) for a case of what appeared to be influenza. Be that as it may, Dr. Bob also saw the child in June 2014 for headache with a history of being hit on the head with a hammer by Dad two weeks prior to visit. According to the Board, there was also a mention of a split lip prior to the hammer incident. However, the physicial examination indicated “no residual marks now.” The Board also noted that no additional physical examination, including the all-important neurological examination (in cases of head trauma), was performed and no assessment with plans recorded. I used to do trauma, including pediatric trauma, and I know that this is a grossly inadequate evaluation for what might be a concussion, based on symptoms and timing, after having been hit in the head with a blunt object. One also has to wonder if child protective services was involved somehow or whether Dr. Bob reported the incident as possible child abuse, as the law requires a pediatrician to do when he suspects possible child abuse. I suspect that most pediatricians, upon seeing a child reportedly hit on the head with a hammer by his father, even if it was reportedly accidental, would report the incident, particularly if there were reports or signs of other injuries, like the split lip.

[Note: Since I posted this, it’s been pointed out to me by commenters that the reference to “An Emergency Response Notice of Referral Disposition” in the complaint likely indicates that Dr. Bob did think enough of the story to report the incident, as it is also mentioned that it also had a notation of “Allegations cannot be substantiated—case closed.” Of course, that Dr. Bob believed the story enough to have reported it makes his failure to do a proper neurological examination all the more egregious a failure.]

Be that as it may, the bottom line is that Dr. Bob did see J.G. a few times for various medical issues. One of those issues was how he dealt with the child’s head injury. The other issue that drew the attention of the board was this:

The standard of care requires that a physician evaluating a patient for a possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction/reactions that occurred. Based on that information, the physician should provide evidence-based recommendations for future immunizations.

Respondent was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making proior to determining to exclude the possibility of future vaccines, leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.

Based on Dr. Bob’s granting of the medical exemption to vaccinations for J.G. and his failure to do a neurological examination of the child when he presented with persistent headaches after head trauma, the Board listed the first cause for disciplining Dr. Bob as gross negligence. The second cause for discipline was repeated negligent acts, given that there were two instances of gross negligence included in the complaint. The third cause for discipline was failure to maintain adequate and accurate medical records.

The complaint calls for:

  1. Revoking or suspending Physician’s and Surgeon’s Certificate Number A60936 issued to Robert Sears, MD;
  2. Revoking, suspending, or denying approval of his authority to supervise physician assistants, pursuant to section 3527 of the Code;
  3. If placed on probation, ordering him to pay the Board the costs of probation monitoring;
  4. Taking such other and further action as deemed necessary and proper.

The complaint is dated September 2, the Friday before the Labor Day weekend. Not surprisingly, now that the Board’s complaint is public, the merry band of antivaccine loons at Age of Autism is up in arms, and other antivaccine sites are, predictably, referring to the Board’s disciplinary action as a “witch hunt.”

When I saw the news story, I must admit that I was surprised. This incident occurred before the passage of SB 277. Why did Dr. Bob write a letter supporting a medical exemption to school vaccine requirements for J.G.? He didn’t need to. The mother could have just gotten a personal belief exemption. So why did Dr. Bob do it? Why did the mother ask him for an exemption? Didn’t she know about personal belief exemptions? At this time, I just don’t know. The other issue that puzzles me is why the board chose this case. True, it’s pretty egregious not to have examined J.G. properly when his mother brought him in with persistent headache after head trauma. (Very sloppy doctoring there, Dr. Bob.) It’s also pretty questionable to have written a letter supporting a medical exemption based on J.G.’s history and such dubious reasoning. As bad as these lapses were, normally a state medical board would probably not bother with them, as underfunded and outmanned as they usually are. Yet California is going after him. Like Steve Novella and Reuben, I definitely approve of the Board’s willingness to take this risk.

I suspect that the Board wants to make an example out of Dr. Bob, which to me is also a good thing. He’s a high profile antivaccine doctor whose Vaccine Book is widely read by parents and supports an “alternate vaccine schedule” that is based on fear mongering rather than science, and lately he’s been opining on how the measles isn’t that bad while laying down a lot of other antivaccine misinformation. If the Board is successful it will make other antivaccine docs think twice about writing exemption letters based on a questionable history of vaccine reaction and non-evidence-based reasons. It’s also risky, too. Dr. Sears has become an instant martyr to the cause among antivaccine activists, and his family’s celebrity will make it easy for him to grab the limelight and portray himself as wrongly “persecuted” for his “vaccine safety” views. That makes the Board’s action a high-risk strategy to send a message. If it loses, Dr. Bob and those who want to sell medical exemptions to circumvent SB 277 will be emboldened.

I only hope that the Board has the opportunity to add to Dr. Sears’ charges. After all, his selling bogus medical exemptions after the passage of SB 277 using an online form is far more egregious than the incident that the Board is going after Sears for. I suspect that, given Sears’ history, there’s a lot more to be found. I really hope that the father who sent me the letters that Dr. Bob Sears generated based on an Internet form has contacted the Medical Board of California. Now would most definitely be an excellent time to do so.

I’m also expecting all manner of conspiracy theories to flow once the antivaccine movement latches on to this news. Believe it or not, I had nothing to do with this. I will be honest, though. I wish I had.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

292 replies on “The Medical Board of California initiates disciplinary action against antivaccine “hero” Dr. Bob Sears. It’s about time.”

This is rather puzzling. Well, it’s not at all puzzling that the medical care given by Sears is grossly negligent, but, rather, that there is much worse out there Sears has done (and been reported for) that’s received absolutely no response from the California Medical Board. It is worth noting that in the “Parties” section of the Complaint report the sole Complainant as Kimberly Kirchmeyer who “brings this accusation solely in her official capacity as the Executive Director of the Medical Board of California”. She was appointed to this position in 2/2014 after having been an interim director for ~ 8 months and having been with the Medical Board since 1999 ( http://www.mbc.ca.gov/About_Us/Media_Room/2014/news_releases_20140212_director.pdf ) . So this complaint against Sears didn’t come from a parent or physician, nor did it come from someone brand new to the Medical Board.

Al Capone was brought down by tax evasion. My concern is this complaint against Sears reads more like trying to jail him for jaywalking, rather than going after him for something more egregious such as what you reported in late July where Sears had been reported for giving an exemption without even examining the patient. Also, Art Kaplan laid out last year other reasons previously used by the California Medical Board with other physicians as to why Sears should lose his license ( https://www.washingtonpost.com/opinions/revoke-the-license-of-any-doctor-who-opposes-vaccination/2015/02/06/11a05e50-ad7f-11e4-9c91-e9d2f9fde644_story.html?utm_term=.3e1215dd098d ). As you do, I would also like to see more complaints brought against Sears for the grossly negligent care he’s given his patients (he freely admitted half his patients are completely unvaccinated to the LA Times in 2014) and the many parents he has scared out of vaccinating nationwide with his books and social media presence. I worry the Medical Board has already zeroed in on what it wants.

Perhaps the true goal of this complaint is directed at those wanting to hand out vaccine exemptions in California like candy–a strong warning that they had better be prepared to document and defend the exemptions they write. The case you wrote on in late July about Sears not examining a patient might not truly worry the exemption-writing carpetbaggers too much (as in they would always examine the patient), but the idea they might actually have to provide evidence-based recommendations concerning future vaccinations in their notes (gasp!).

I wonder why this case and not the one you mentioned – with no physical exam before exemption – as well. And why was a complain brought, if the mother wanted the exemption?

There are some strange things about this story, though it may just be because it’s a complaint, reflecting a very simplified and aggregated version.

At least they’re looking at his behavior. He has, as you point out, acted in concerning ways for a while now.

I would wonder if this set of (alleged) violations was selected to set a bar for the future. If this action isn’t successful, the can be brought up a little next time.

Welcome news, and hopefully this will lead to more kids being protected from Sears’ self-serving and inadequate care.

I expect, though, that the broader Sears family will bring their celebrity and money to bear on this case, whipping up their fan base into a frothy frenzy.

I have a suspicion that Child Protective Services is somehow involved in this, and also perhaps custody battle. The stuff about being hit with a hammer and the split lip- I think CPS was involved and I wonder if they contacted the board regarding the negligent care.

Speaking of the fan base, AoA has a protest article already up describing the charges (but somehow failing to mention the part about lack of a neurologic exam for the child Daddy supposedly hit with the hammer). AoA’s typically nuanced conclusion:

“You will vaccinate with no question of your health status, religious beliefs or personal stance. This is communism. The government controls you.”

Darn right. You know who really runs the California Medical Board? Putin!!!

And…introducing the newest member of the antivaxx cult’s martyr club. Sears will now join the likes of Wakefield and other victims of the BIG pHARMa Conspiracy.

“Be that as it may, Dr. Bob also saw the child in June 2014 for headache with a history of being hit on the head with a hammer by Dad two weeks prior to visit.”

As other issues have already been addressed, my question is this: In what situation would the incident described above NOT be a mandatory report to CPS? A toddler hit in the head with a hammer by his father. The split lip noted prior to this incident can be passed off on the clumsiness of toddlerhood. My own daughter managed several black eyes from falling on her little face in the first couple years. We never hit her in the head with a hammer. This is not a normal childhood injury. And the second injury that could signal abuse. Why was this not reported by a mandatory reporter to be looked into?

IANAD, but wouldn’t it be worrisome enough to justify at least a call to the doctor, if not a trip to the emergency room, if a baby produced no urine for 24 hours? Or was limp as a rag doll for a day? There should have been records of these events if they really occurred but it sounds like there weren’t and Sears just took the mother ‘s word for it.

Interesting. Dr. Kirchmeyer may be bringing the complaint, but the issue had to come to her attention somehow. I have to wonder how that was, in order for her to know who the child was and obtain the medical records, but hate to speculate.

I bet that becomes an issue in the defense, though.

As a strategy to set up future action against Sears this is pretty good. It focuses on conduct prior to SB277 to show his negligence or gross negligence and if found true, his conduct subsequent to SB277 gets aggravated treatment if subject to medical board action. I suspect a suspended license rather than revocation is what the board is after. Once the license gets reinstated the board can control his conduct via terms of probation which he agrees to in exchange for the reinstatement. If he persists in negligent practice in the future the prior findings seal his fate.

Maybe the medical exemption had to do with parental conflict or a divorce and it’s the other parent that brought the complaint. Pure speculation on my part.

@Paul #9: in the minds of AVers, they are martyred every time they are criticized, even in the slightest. The hard-core AVers flooding the OC Register comments section in his support feel Sears has been martyred many times already. They would follow him of a cliff. My hope is that Sears is professionally disciplined severely enough to show new parents that he is not a doctor deserving of trust. Ideally he gets “struck off” like Wakefield did in the UK. Then Sears can paint “VAXXED” on the side of his Lamborghini and follow Wakefield’s bus around the US.

As PCD and Ami have mentioned above, my suspicion is that the real issue here isn’t the vaccine exemption but the failure to report child abuse to the authorities. The claim that J.G. had been hit on the head with a hammer should have raised eyebrows at the time. It also suggests that the father wasn’t the one to file the complaint, unless the mother is the abusive parent who is falsely blaming the father for the abuse (crazy spouses and ex-spouses have been known to do this). The mother got the vaccine exemption she wanted, so it’s unlikely that she’s the complainant. That leaves CPS as the only organization that would have standing here.

Meanwhile, Patty Bolen is merely fixating on HBOT and “ozone therapy.” Not leadership material.

The claim that J.G. had been hit on the head with a hammer should have raised eyebrows at the time. It also suggests that the father wasn’t the one to file the complaint, unless the mother is the abusive parent who is falsely blaming the father for the abuse….

I think you’re getting way ahead of yourself here. (Also note that “standing” isn’t required to register a complaint with the
Medical Board of California.)

I hate to take pleasure in another human being’s misfortune, however richly deserved, but it’s deeply satisfying to see Dr. Bob (potentially) brought down by his own greed and hubris in true comic book super-villian fashion.

Her description included, “shut down stools and urine” for 24 hours with 2 month vaccines and limp “like a ragdoll” lasting 24 hours and not himself for up to a week after 3 month vaccines.

This is so typical of the “vaccine injury” stories we see all the time that sometimes I wonder if they’re read from a script. The parent describes what sounds like a pretty run-of-the-mill post-vax malaise which a) apparently wasn’t severe enough to take the kid to a doctor, since there’s no medical record, and b) didn’t stop the parent from taking the kid back in for more shots a month later, but which now, years later and under the influence of the anti-vax movement, has morphed into vaccine-induced encephalitis and multiple organ failure. I mean, I get that even a mild vaccine reaction can be scary for a new parent, but in all the research they claim they’ve done they somehow missed the fact that vaccines work by inducing an immune response and that mild flu-like symptoms are a totally normal part of that? So much so, in fact, that I’ve often wondered if there’s any correlation between mild vaccine reactions and efficacy.

“State Medical Board’s Balls Finally Drop” – every pediatrics newsletter. Fingers crossed.

Last week you mentioned Sears when you reported on the AAP getting tougher on vaccine exemptions, which analyzed the American Academy of Pediatrics (AAP) position paper on vaccine hesitancy and refusal. Near the end of the your article you state:

One thing that’s missing from the AAP statement is a discussion of pediatricians who promote antivaccine misinformation, such as “Dr. Bob” Sears, who not only promotes antivaccine pseudoscience but is basically selling highly dubious medical exemptions online to help parents get around SB 277. The AAP needs to come out forcefully to condemn such physicians in no uncertain terms and then to take action to show that their words are more than just words. That action would be to expel such pediatricians from their organization.

It’s no surprise I, too, want FAAP Sears (along with fellow FAAPs Jay Gordon and (most recently) Paul Thomas) expelled from the AAP for their anti-vaccinationism. Well, that AAP position paper has a comments section, and I submitted this comment.

Here is the AAP’s response from Mark Neuman, MD, MPH, an assistant editor at Pediatrics and also an associate professor in pediatric emergency medicine at Boston Children’s Hospital:

Dear Dr. Hickie.

Thank you for your comment submission to Pediatrics.

We cannot post the comment as written, but would consider re-reviewing if you tone down the rhetoric. Specifically, would help if you could broaden the scope to address anti-vaccine pediatricians (rather than solely addressing Dr. Sears).

If you would like to submit a new version, we would be happy to review it again. This link provides the author instructions: http://www.aappublications.org/content/pediatrics-author-guidelines#reader_comments

Please note: Resubmission of your comment should again be done online, not as a reply to this email.

Sincerely,

Mark Neuman MD MPH
Assistant Editor, Pediatrics

Given what I’ve stated is fact regarding Sears, I’m not sure what rhetoric needs toning down. Again, just how damned dangerous does Sears have to be before the AAP will address him (even now he is rallying his Luddite minions on his Facebook page by posting on this Medical Board Complaint)? Can Sears only be criticized once by the AAP and then only not directly by the AAP but via the Offit/Moser paper from 2009? I’m glad to see the Medical Board of California is now seriously taking Sears to task, but the AAP still is full of AAPathy with respect to combatting anti-vaccinationism, which is a damn shame.

Well, they did say “broaden it”–maybe start by saying “anti-vaccine physicians such as Dr. Bob Sears” instead of just naming him. The only toning down I can think of offhand would be that they may be unhappy about the word “disgraceful.” How would “clear” or “major deviation from the standard of medical care” do? And maybe “This disregard for public health was borne out…” instead of “this is a disgraceful disregard…”

What is particularly troubling about the complaint is the suggestion that treatment must be tailored not just for the best interests of the patient, but for the best interests of the patient’s ‘future contacts’–i.e., others.

The vaccine exemption is not the least bit concerning. The parent reported the previous adverse vaccine reactions, and apparently wanted the exemption, having decided not to consent to further vaccinations.

It’s interesting that a doctor with such a moderately ‘noncompliant’ stance regarding vaccine doctrine would be targeted. It wouldn’t be surprising to learn that the underlying impetus is a contentious divorce or custody battle.

His appeals to his fan base will no doubt frame this as persecution due to his anti vaccine stance.
This is not a vaccination issue.
One (very) simple version of events is that, he can give a medical exemption if he follows a certain process.
He didn’t do so.

If he prescribed medicine x to someone under 10 years old and the protocol said “not to be given to under 10s” then the resulting consequence should be the same.

Also note that “standing” isn’t required to register a complaint with the
Medical Board of California.

Maybe “standing” isn’t the right word (IANAL, nor am I a resident of California). But because of HIPAA, there aren’t many people who could legally have known enough about J.G.’s medical history to file this complaint. The parents or legal guardians, of course. If J.G. were later seen by another physician, this physician would have a legitimate need to know the medical history–there isn’t enough information to determine whether this other physician, if he exists, was the guy who called CPS’s attention to the case or whether he was brought in by CPS (in the latter case, the doctor would have known to look for such things). Alternatively, there might be a whistleblower in Dr. Bob’s office. The CPS case manager (whatever the correct title is) would have legitimate reason to know. The other possibility is that if there is a custody battle in progress and a legal representative for the child has been appointed, this representative might be considered a guardian for HIPAA purposes.

The point is that the complainant has to have known of J.G.’s previously being a patient of Dr. Bob, and that the complainant must have had some reason to look at the details of that relationship. There is no upside for either parent to have done this, unless one is defending against the other’s false accusations of child abuse: it is generally known that convicted child abusers are regarded by other prison inmates as the lowest of the low and are treated accordingly. A whistleblower would probably complain about other cases, not just J.G.’s. That leaves either CPS or a custody battle, and if CPS were not involved prior to the custody battle, they almost certainly are now.

You misrepresent information so effortlessly, it is really something to behold. You make baseless claims but then include a link which is supposed to give the appearance of substantiating your claim. Example, you cite yourself (what a surprise!) in your claim “Given Dr. Bob’s history of … and even outright selling nonmedical exemptions”. Well I read your blog entry you cite, and nowhere in it do you provide ANY shred of evidence that Dr. Sears or anyone else is “selling nonmedical exemptions”.

So shame on you.

As for this current “scandal”, is it or is not not within the medical doctor’s discretion whether or not to grant a medical exemption? While Pan and Allen were pushing for SB277 they argued repeatedly, in order to assuage concerns from lawmakers and opponents of the bill, that yes, indeed, doctors will be able to use their own medical judgement when deciding whether or not to grant medical exemptions in order to protect children who may be at an increased risk of injury from vaccination. But then what happened once this bill was passed? In some counties the health agencies decided they would scrutinize all medical exemptions, as if they have the expertise and the right to do so.

And what is happening now? Even you admit that the Medical Board is likely trying to make an example of Dr. Sears. Like others who have come before him, Dr. Sears in this case is only guilty of one thing…listening to a parent who is trying to protect their child.

David Foster @29: You seem to be under the impression that there are no standards in medicine. Yes, Dr. Sears was allowed to make a vaccine exemption, but only after taking a fully history. He did not do that, so his vaccine exemption is in error.

When a patient presents with head pain and a history of injury to the head, the standard of medical care says that the doctor performs a neurological exam. Dr. Sears failed to do that in the case of this patient.
Dr. Sears is in trouble with the board for doing his job wrong.

Frankly, any pediatrician who fails to do basic checks on a child with a head injury inflicted by a parent is in dereliction of their oaths as a doctor and a mandated reporter.

David Foster @29: “Doctor Bob” clearly should have examined contemporaneous records rather than rely on parental report. If the Wakefield debacle isn’t enough to convince you, consider the discrepancy between parental report and medical records in this case:

BS Hooker said this of his son in “Vaxxed: “Two weeks after his 15 month vaccines, then he lost all language. He lost all eye contact. You would pick him up and he would just hang limp.” However, the public documents from Hooker’s failed suit in “Vaccine Court” stand in marked contrast: the records and make it clear that nineteen days following receipt of those vaccines the Hookers took their child to the pediatrician because of concern that the scheduled surgical placement of “ear tubes” might have to be delayed because the Hookers suspected that he had an ear infection. They did not mention that he had “lost all contact” or “lost all language” or that “he would just hang limp.” The medical records clearly note that other than low-grade fever and symptoms of a cold, “no other recent symptoms were noted.” No other symptoms, such as no signs that “he would just hang limp,” etc.

Should “Doctor Bob” grant Hooker’s son a life-long medical exemption from vaccination based on what he says and perhaps mistakenly believes?

Mr. Foster, the report said the child had been hit by a hammer by the father. That is very serious, and should have been followed up.

You do understand that hitting a toddler with a hammer is not healthy for the child. It is right up there with making sure the kid gets chicken pox and other vaccine preventable diseases.

Let me get this right….You want to get rid of a doctor because he is looking out for the best interest of his patient…. a patient that had a bad reaction to a vaccine… and you assholes want to give the kid a vaccine again??? WTF is wrong with you people. You’re a bunch of sick, satanic assholes.

No. I can’t speak for others, but before a doctor decides a child doesn’t get protected from disease, I want him to actually have a basis.

A diagnosis of encephalitis based on nothing, no tests or records, isn’t such a basis, nor are the other claims by the mother.

I would also like a doctor faced with a two year old whose dad took a hammer to his head, according to the mom, to test and make sure the child is okay.

When a doctor fails a child multiple times like this, I’m glad to see the board step up.

Let’s put aside the vaccine exemption for a moment. You have no criticism for a doctor that apparently doesn’t check up on a two year old that, he heard, got a hammer to the head?

I wonder how many people on the California Board of Medicine have ties to Merck?

Why don’t you check?

^ Here, given that there’s no such thing as the “California Board of Medicine,” I’ll help get you started: Correlate this with this.

I haven’t looked, so there’s no telling from my perspective.

My hypotheses: Dad never hit J. G. with hammer. Sears didn’t order a neuro exam or file a CPS report because it there was no evidence J. G. had been struck with a blunt object and suffered a concussion, and he did not believe Mom’s story. Dad is the source for the Board. He’s suing for custody of J. G., Dr. Bob has been supporting Mom in the litigation, and Dad wants him discredited (probably with good justification).

Rationale:
1) A two-year-old struck in the head with a hammer would more likely be dead than suffering a headache.
2) The complaint reads “leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.” The absence of Dad from this language suggests Dad is no longer in contact with J. G., Mom currently having sole custody.
3) The complaint notes Sears first saw J. G. for a “two year”, 10 days before he drafted the letter supporting the medical exemption. Thus Dr. Bob was not the physician who administered the immunizations, and would have noted any reactions. This suggests Mom went exemption-shopping when she couldn’t get what she wanted from J. G.’s previous pediatrician, who may have known there was no serious adverse reaction to report. The doctor switch may also have been related to the parents’ separation and custody struggle, i.e. Dad wanted the kid to see the legit doctor.

Analysis: If I’m right, and Sears has to defend himself on the ‘hammer’ thing by saying he didn’t believe Mom’s crazy account of J. G.’s headache, he’s screwed on taking Mom’s word for J. G.’s ‘adverse vaccine reactions’ and approving a medical exemption w/o getting medical documentation of what vaccines J.G. had received and his reactions to them.

Since the link above now returns a 404 error, here’s the exact language from the complaint about the hammer:

On June 23, 2014, patient J.G. presented to Respondent with a chief complaint of headache with a history of patient being “hit on head with hammer” by Dad two weeks prior to the visit. A mention is made of a split lip prior to hammer incident without any additional history. A physical examination indicates, “no residual marks now.” No additional physical exam including neurological testing, was performed and no assessment with plans was recorded…
Respondent departed from the standard of care by failing to conduct neurological testing as part of the physical examination of patient J.G. on June 23, 2014, when he presented to Respondent with complaints of headache, following head trauma…
Respondent failed to maintain adequate and accurate records related to the care and treatment of patient J.G. Specifically, he failed to document an adequate physical examination of the patient on his visit of April 23, 2014, and merely wrote, “no residual marks.”

A two-year-old struck in the head with a hammer would more likely be dead than suffering a headache.

Your rationale falls apart right there, because this is not true. You seem to be assuming that the dad swung the hammer with all his might, when it is rare for a parent to do something like that unless it’s one of those rare parents who is striking with lethal intent. More commonly, such injuries are due to the adult wanting to “teach the kid a lesson.”

Finally, even if Sears didn’t believe the story, the very fact that the mother reported it absolutely mandates a careful neurologic examination of the child, which Dr. Bob did not do. Now, maybe he did do it and didn’t document it, but in medical law if it isn’t documented it wasn’t done.

Also, it is very risky for a mandated reporter, like a pediatrician, to dismiss a story stating that a child was hit in the head with a hammer that has even a germ of credibility. If a mandated reporter turns out to be wrong in not believing the story, he would be putting himself in grave legal jeopardy. It’s far safer to let CPS look into it.

I do agree, though, that it is very likely that there very likely is divorce and/or child custody litigation going on, with Dr. Bob being the preferred pediatrician of the mother. Also, your speculation that the mother switched doctors because the original pediatrician wouldn’t go along wither her desire not to vaccinate and picked Dr. Bob instead is plausible.

You seem to be assuming that the dad swung the hammer with all his might

I’m just coming to from another wretched postprandial nap-like experience, but in the complaint, is this anything more than “some sort of hammery object held by father somehow came into contact with child’s head”?

Good thing I saved the PDF, as the Medical Board appears to have removed the complaint from its website.

It’s all very vague. At the visit the chief complaint is reported as headache, with a history of being “hit on head with hammer” by Dad two weeks prior to visit. That’s all the description.

@Eric Lund:

Omitting the prison talk:

The point is that the complainant has to have known of J.G.’s previously being a patient of Dr. Bob, and that the complainant must have had some reason to look at the details of that relationship.

Yah, OK, but I don’t know what sort of investigatory powers the MBC has, and it could have been a next friend, etc. It just strikes me as quite premature to be playing Professor Plum with a candlestick in the billiard room.

Prof. Reiss:

Dr. Bob did put “An Emergency Response Notice of Referral Disposition dated June 25, 2014 with “Allegations cannot be substantiated – case closed” outcome” iin J. G.’s chart.

So the question for ‘Brian’ should probably be, ‘You have no criticism for a doctor so credulous or unethical that when his client explained her two-year-old’s routine headache as the result of being hit “on head with hammer” by Dad, despite physical evidence that this allegation was a fabulation, he wrote that this actually occurred in his records anyway?”

I don’t a good basis here to be confident it isn’t true, and I don’t see the doctors, who actually have expertise in this, saying that.

As Narad pointed out, I don’t know that we have enough to reach any conclusions on who complained. I think he made a strong point on that.

Well, rats.

My sister from CA is visiting next week, and my plan was to recruit her in my quest to get a vaccine exemption for my neighbors dog (I was going to use her mailing address).

Now I’ll need to wait and try after Sears (hopefully doesn’t) “survives”.

Brian: “…. a patient that had a bad reaction to a vaccine”

How do you know that? That paperwork seems to not exist. Quoting from the quoted part in the article:

“The documents say Sears failed to obtain a detailed medical history documenting the unidentified boy’s prior vaccines and reactions, …”

and: “Respondent for what medical records describe as a “two year.” The visit of this date includes a summary of the patient’s history with a brief description of J.G.’s prior vaccination reaction, as described by the patient’s mother.”

Apparently there were no medical records of that dire reaction. If anything Sears is being disciplined for very lousy record keeping, especially of a child with severe neurological impacts.

Those records are extremely important if that child needs special education supports and to qualify for disability services. My son’s seizures and developmental history have been well documented, which have been crucial in getting him the services he needs.

It is almost a criminal act if Dr. Sears lazy record keeping prevents that child getting services (which are not easy to apply for).

@ Orac #40:

I ran all the scenarios I could imagine of “some sort of hammery object held by father somehow came into contact with child’s head” through my head, and didn’t come up with anything plausible. I can’t imagine an adult wanting to “teach the kid a lesson” doing so with a hammer, as the it would take a fine touch to separate punitive force from seriously injurious force, and so many less dangerous ‘educational instruments’ would be available.

So, yeah, if a parent waits two weeks after a concussion to take a toddler to a doctor, and then the kid shows no evidence whatsoever of his headache having been caused by blunt force trauma, I think a mandated reporter might conclude Mom’s story didn’t have even a germ of credibility. Or, more to the point of AV wacky, since Dr. Bob actually listened to Mom’s explanation, he may have recognized verbal and non-verbal cues indicating the story was, uhhh, the ravings of a nut-job, or something like that…

Ah, but he did place “An Emergency Response Notice of Referral Disposition” in the chart. When I first read the complaint, I wasn’t clear on what that meant and it was late and I was tired, but it now looks to me as though he did file a report to CPS and that the allegations could not be substantiated. (I might even go back and make a note to that effect in the post itself.) My interpretation now is that Dr. Bob did think enough of the story to report it to CPS, which makes his failure to do a good neurological examination on JG just as egregious as I described it and just as much sloppy doctoring as I described it.

Two weeks is long enough for a bump on the head to subside, and you don’t have to have a fracture to have a significant closed head injury, such as a concussion or subarachnoid hemorrhage.

@ Chris #49

Dr. Bob wasn’t J. G.’s pediatrician when J. G. got the shots, so that’s not his record-keeping problem. I read the complaint as asserting Sears issued the medical exemption solely on Mom’s account, without obtaining J. G.’s records from J. G.’s prior pediatrician. My hypothesis would be that Dr. Bob didn’t request the records because he suspected Mom’s descriptions of “shut down stools and urine” for 24 hours after 2 month vaccines and limp “like a ragdoll” for 24 hours after 3 month vaccines were fabula the records would not support, and knowing what the records would say he could not write the exemption letter Mom desired (and was paying cash for…).

Good thing I saved the PDF, as the Medical Board appears to have removed the complaint from its website.

It’s still there, wrapped in a crappy interface: In my case, enter license number 60936 here, click on the row itself, and rename ‘document.aspx’ to ‘something.pdf’.

@Orac

It looks like the full complaint is still available. When I went to the Medical Board of California, clicked on Public Documents, and then Enforcement Public Document Search, I was able to find the complaint by searching on Dr. Sears’ name.

Better to go after Sears for this shoddy medical care than the egregious web exemptions. Why?

Watch out Jay Gordon.

@ Orac and Prof. Reiss:

My hypotheses are just that, not conclusions made with any confidence. I certainly don’t dismiss the possibility that the presentation of J. G. and Mom’s story did warrant a neuro exam, or that someone other than Dad contacted the Board.

As for the “Emergency Response Notice of Referral Disposition”, I’d guess Sears felt obligated to file something regardless of how credible he found Mom’s tale. Since that notice is dated 6/25/14 and the office visit was two days prior, I’d guess Dr. Bob was able to to make enough inquiries with J. G., Mom, and maybe third parties such that, along with his physical exam of J. G., allowed him to rule out significant closed head injury and conclude “Allegations cannot be substantiated”, to put it mildly. Regardless, I’d think he failed his de facto (if not de jure) responsibility by failing to document how and why he concluded the “allegations cannot be substantiated” beyond the initial note of “no residual marks now.” My hypothesis (just a guess, now) would be that he chose not to explain because it would have looked bad for Mom, who he was attempting to ‘serve’ and cultivate as an ongoing cash-paying client.

@Madison MD #56: Somehow in 2006 Gordon escaped losing his license when he failed to test a child for HIV who had an HIV-positive mother as well as the patient herself having failure to thrive and a persistent cough. The child died shortly thereafter. You can read about it here: https://en.wikipedia.org/wiki/Eliza_Jane_Scovill?wprov=sfla1 .

Its shameful that apparently nothing happened to Gordon over this.

Before my head explodes, does anyone know offhand whether § 2227(b) of the California Business & Professions Code is necessary for making the document public? (Yah, yah, I just wanted to write it down before I forgot.)

sadmar: “Dr. Bob wasn’t J. G.’s pediatrician when J. G. got the shots, so that’s not his record-keeping problem. I read the complaint as asserting Sears issued the medical exemption solely on Mom’s account, without obtaining J. G.’s records from J. G.’s prior pediatrician”

This is where it is a problem. The follow up physician needs to get the records from the previous physician. This has been easily done for both of my son’s neurologists and cardiologists to our family physician.

If Dr. Sears could not get those records, he needed to record that. As it is.. a letter he wrote in 2014 is missing. He has failed to keep on top of basic record keeping. Very important record keeping.

This may be because he hired a totally incompetent office manager. But even if he hired the best one, they cannot work unless he directs them to contact the previous doctor.

By the way, I was given copies of much of this paper work. Which I kept. It has been scanned and converted to easily transferred PDFs. While I can fault the mother for not keeping stuff… she should have been able to get records from the medical clinics. Something I have also done from two different medical entities at the request of the Mayo Clinic prior to my son’s open heart surgery.

Seriously, I know the drill.

Those records are important. It is why the Mayo Clinic sent a fellow pretty much running across Rochester, MN to St. Mary’s Hospital to stop the cardiac MRI my son just as he was finished getting prepped. Apparently they had just reviewed the cardiac MRI from our local university hospital and deemed it sufficient.

Sending them those medical records by the most expensive registered mail available was worth it to save both the health insurance company several thousands of dollars and my son from spending any more time in one of those very noisy claustrophobic machines. I have some very special comments on the Mayo Clinic policy of “waiting until the lasts minute” to deal with previous medical records. (I decided to walk the halls of that rather historic hospital while son was getting prepped, and then I got a frantic call on my phone, so I returned to the MRI waiting area to speak to a very out of breath medical fellow… who told me that my son who was prepped/gowned and ready to go did not have to get that particular MRI).

Did anyone mention that Sears was getting trouble mostly because of his crappy records management? Only someone who has never had any complicated medical issues would think that is trivial. It is not.

And now, here’s what happens when a state medical board abdicates it’s sworn duty (despite 38 complaints against this quack): Jack Wolfson, DO, FACC is now making a movie to presumably show how amazing he was back last year when he said children need to get measles, mumps and chicken pox and also said that he wouldn’t feel bad if his unvaccinated child gave a fatal VPD to an immune compromised child.
https://www.facebook.com/creativedoorway/photos/a.360170897472953.1073741834.351105505046159/669491253207581/?type=3.

The local CBS radio news station had a brief story on the Sears investigation this evening (Friday), including mentioning him by name. They didn’t provide a response from either Sears or his representative. I would guess that this is the first time that most listeners have ever heard of him.

Competent Medical Professionals never said that patients won’t die from vaccines, they likely will. We have merely stated that by receiving the vaccine we are reducing the risk of death at least ten-fold. The state medical board California Medical Board did their job and it made national news. However, in reference to other state medical boards such as Missouri, the past is prologue http://dx.doi.org/10.4172/2375-4273.1000155 – a history of repeatedly misrepresenting evidence.

Just clarify for those commenting about Dr. Sears giving an ME with just an online questionnaire and a fee without an exam is completely false.

“Did anyone mention that Sears was getting trouble mostly because of his crappy records management?”

For the medical professionals in the house — would Sears’ casual attitude towards records keeping be due in part to his not accepting insurance? I can’t see any insurance carrier putting up with a practitioner who didn’t dot all the i’s and cross all the t’s.

@ Shay #67–not necessarily. Sears probably takes cash-only so he doesn’t have to deal with the hassles of getting paid by insurance companies (and it is a hassle). It also gives him a faux air of “I’m too good for insurance companies” that a lot of “holistic” quack doctors have (though depending on what “therapies” they offer, insurances might not credential them anyhow. Also, as I’ve said, Sears may not even carry medical malpractice insurance (which insurances require but the State of California does not) which would save him 20-30K a year. But as a licensed physician, regardless of his practice model, Sears is required to keep adequate patient notes and also be competent in his skills–that is what has him in hot water right now. Also of interest (to me at least) is that the pictures of Sears in the last few years in his office show lots of paper charts–indicative to me that he isn’t even technologically adept enough to go to electronic records–but hey, what do you expect from a doctor who practices like vaccines don’t matter?

Dr Hickie — thanks. My experience was in public health, and I didn’t work on the clinical side.

For the medical professionals in the house — would Sears’ casual attitude towards records keeping be due in part to his not accepting insurance? I can’t see any insurance carrier putting up with a practitioner who didn’t dot all the i’s and cross all the t’s.

I think it could indeed be in part due to his not accepting insurance. For one thing, insurance companies will require CPT codes and now ICD-10 codes for billing, and those have to be documented. An EMR makes that easier. Basically, Sears’ record-keeping strikes me as very, very old school, back from the 1970s, before managed care and before DRGs, when scribbled notes without a lot of detail could be adequate. In 2016, such record keeping won’t fly any more. It’s considered grossly inadequate.

One thing I’m unclear about is how Sears didn’t see this coming 10 miles away. Did he think the medical board would never act? I seem to recall that he wrote somewhere (can’t remember where) that he had insiders in the CA medical board telling him he was safe from discipline. What changed?

I mean, he must be provoking the ire of other physicians than Chris Hickie. If I practiced in OC and he gave one of my patients a med exemption for flimsy or fabricated reasons, I would discharge the family from my practice and report him to the medical board.

#71

Isn’t it odd to use a photo of a dead guy as your avatar?

I use a picture of a (now) dead cat as my avatar.

@Shay Simmons #69, I was military and we never dealt with insurance companies, but we had to keep accurate records.
Detailed as possible, if it wasn’t documented, it never happened kind of documentation and an error in documentation may well be the difference between a service member receiving a VA disability rating and not receiving one that they earned the hard way.
Now, we didn’t have ICD codes to contend with or CPT codes, especially in the field and field clinics (such as a battalion aid station), but we were required to utilize standardized terminology, standardized drug names and a baseline physiological measurement of “WNL” didn’t mean Within Normal Limits, it meant “We Never Looked” and was actionable on a disciplinary level.
I’d feel badly enough to fail so badly as to be castigated by the physician, I’d feel far worse if our patient’s care suffered or worse, a patient got screwed out of his deserved VA care and disability.

Interestingly, when that was explained to even our lowest Private, fresh out of Fort Sam, they instantly grasped the importance of those records.
Guess who became the resident medical encyclopedia and dictionary? I didn’t have a problem with that, as that turned into training sessions.
Which were then documented, satisfying command that no matter where we were, we were training.

As for neurological examination after a blunt trauma to the head, we had a soldier fall from the back of a 5 ton cargo truck (we use the trucks to carry either cargo or personnel, but both should never be carried at the same time for safet reasons). Several days later, he complained of blurring vision, all sign of his fall already being healed. While we were examining him, his speech began to slur.
We arranged immediate evacuation to a local civilian medical center with significant diffuse edema of his brain and a modest bleed. He arrived at the local trauma center unconscious, unresponsive to painful stimuli.
After treatment, he returned to duty uneventfully, several months later.
Had we did the Bob Sears number, he’d have expired.
His prior complaint before the blurring vision? Headaches, which weren’t reported to us at the time, but cropped up during the history.

Dr. Hickie,

That Wolfson film is no more a documentary than any of Eric Merola’s informercials for Burzynski.

I spent some time at the production company Creative Doorway’s website. They’re a branding outfit that churns out marketing films for clients, from storyboard to final print. So essentially “The Drs. Wolfson” (a brand they’ve set up with dozens of products to sell) commissioned this production house to make a commercial for their brand.

At least the company is honest about they do:

“Creative Doorway is a creative marketing company that specializes in innovative brand image fabrication. With a skilled team designed to devise the ideal package for company and or personal branding uniqueness.”

Unlike Merola, Wakefield and many others, they admit this is nothing more than a commercial.

The same company is also doing a marketing film for a stem cell clinic.

I doubt if “Wide Awake” will be an Academy Award nominee next year.

#75

#73 Is the photo taken from the obits page of an online paper?
Most people photos I’ve seen are understood to be the poster.

I have the impression that Brett is using it to imply a gravitas that he may feel is lacking in his own photo. But perhaps Brett could explain better…

You may assume that. I don’t. But I also don’t make assumptions about people’s character based on their avatars.

Hmm. Perhaps Bob Sears could have saved that child from abuse if he had reported the incidents, but he did save some face by exempting a child from aluminum poisoning and a possible cytokine storm.

So all in all, Bob Sears is aboutpar for the course.

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